MIT Student Health Plan

Transcription

1 MIT Student Health Plan - Insurance plan rates - How do I enroll or waive coverage? - Your medical benefits - Health plans offices - Commonly used terms - Useful contact information

2 Insurance plan rates MIT Student Medical Plan All students taking at least 12 units per term are enrolled in this plan. The cost is included in your tuition and covers most services provided at MIT Medical, our multi-specialty, on-campus health center. You can enroll family members in the Student Medical Plan for an additional charge (below). MIT Student Medical Plan BOTH TERMS Sept. 1, 2016 Aug. 31, 2017 FALL TERM ONLY Sept. 1, 2016 Jan. 31, 2017 SPRING TERM ONLY Feb. 1, 2017 Aug. 31, 2017 Student (automatic enrollment) No cost (included with tuition) No cost (included with tuition) No cost (included with tuition) Student and spouse/partner $1,440 $600 $840 Student and dependent(s) $720 $300 $420 Family (student, spouse/partner, and dependents) $2,160 $900 $1,260 Please note: This plan does not provide complete coverage as required by state and federal law. Students must carry additional insurance to meet state and federal requirements. MIT Student Extended Insurance Plan (SEIP) This plan complements the coverage provided by the Student Medical Plan and meets state and federal requirements for comprehensive coverage. The Student Extended Insurance Plan includes prescription coverage and covers off-campus services such as emergency room visits, surgical procedures, and inpatient hospital stays (including maternity and inpatient mental health/substance abuse care). In order to enroll in the Student Extended Insurance Plan, family members must also enroll in the Student Medical Plan. MIT Student Medical Plan + Student Extended Insurance Plan BOTH TERMS Sept. 1, 2016 Aug. 31, 2017 FALL TERM ONLY Sept. 1, 2016 Jan. 31, 2017 SPRING TERM ONLY Feb. 1, 2017 Aug. 31, 2017 Student (automatic enrollment) $2,796 $1,165 $1,631 Student and spouse/partner $5,772 $2,405 $3,367 Student and dependent(s) $3,756 $1,565 $2,191 Family (student, spouse/partner, and dependents) $6,732 $2,805 $3,927

3 How do I enroll or waive coverage? Students If you re registered for at least 12 units per term, you are automatically enrolled in the Student Medical Plan (the cost is included with tuition). If you are a full-time student or are registered with at least 75 percent of the academic requirement, you will be automatically enrolled in the Student Extended Insurance Plan as well. Charges for this coverage will automatically be billed to your student account. If you want the Student Extended Insurance Plan, you don t need to do anything. If you wish to waive your Student Extended Insurance Plan coverage, and you have other coverage that meets Massachusetts requirements, you must complete the online waiver form at medical.mit.edu/waive by September 15 for the fall term, February 15 for the spring term, or June 15 for the summer term. In the fall, you can waive for the entire academic year. Before waiving, read the online FAQs and be prepared to provide proof of comparable insurance coverage. Please note: the Student Extended Insurance Plan covers benefits not included in the Student Medical Plan but required by federal and Massachusetts law. If you are covered by another comprehensive insurance plan in addition to the Extended Plan, your other plan will be the primary insurer. All students who waive the Student Extended Insurance Plan must provide proof of comparable insurance coverage. You will be responsible for paying for the Student Extended Insurance Plan if you do not waive by the deadline. Visiting students and students taking between 12 and 27 units per term are eligible to enroll in the Student Extended Insurance Plan, but enrollment is not automatic. To enroll, you must come to the Health Plans Office in E Family members of students Students may enroll partners (spouses or spousal equivalents) and dependents (children up to 26 years old) in the Student Medical Plan and the Student Extended Insurance Plan. Family members must enroll in the Student Medical Plan to be eligible for the Student Extended Insurance Plan. To enroll family members, come to the Health Plans Office in E and bring proof of your family members eligibility for coverage. Proof of eligibility includes: A marriage certificate for you and your spouse. A Domestic Partner/Spousal Equivalent Affidavit of Domestic Partnership form for you and your spousal equivalent and proof that you are living together (get a copy of the form and examples of acceptable documentation at the Health Plans Office or download a copy at medical.mit.edu/pdf/spousal.pdf A birth certificate for your dependent child(ren) that shows the name of the children and the name of the parent or a passport that shows the parent/child relationship. Family members enrolled in the Student Medical and Extended Plans are automatically re-enrolled for the next term as long as you are an eligible student. Each term is billed separately. You can enroll family members for health insurance coverage at the same time you enroll or at the beginning of an academic term (September 1 or February 1). If your family members arrive in the United States from another country after you, you must enroll them for health insurance coverage within 30 days of their arrival. You will need to provide proof of the date they arrived, such as a stamped passport, visa, or airline ticket. Visit medical.mit.edu/waive by September 15, 2016 to waive coverage. 3

4 Your medical benefits Your cost at MIT Medical (services are covered under the MIT Student Medical Plan unless otherwise indicated) Your cost for services outside MIT Medical covered only if you are also enrolled in the MIT Student Extended Insurance Plan Your cost for benefits using the Blue Cross PPO Network (see Innetwork provider on page 7) Your cost for out-of-network provider benefits (see definition on page 7 for more information) Outpatient care Emergency room visits Well-child visits Routine adult physical exams, including related tests (pre-matriculation exams and shots are not covered) Allergy testing and serums Routine immunizations, including flu shots Not available at MIT Medical Covered in full Covered in full; available only at MIT Medical Covered in full (serums covered if you are enrolled in the Extended Plan) Covered in full (Gardasil is covered if you are enrolled in the Extended Plan) $50 copay per visit (waived if admitted) Limited coverage for children up to and including age 5 Deductible waived; $50 copay per visit (waived if admitted) $25 copay Travel vaccines (yellow fever, typhoid, etc...) $25 copay Routine gynecological exams, including related lab tests (one per calendar year) Covered in full; available only at MIT Medical Maternity care Covered in full, if you are enrolled in the Extended Plan Covered in full 20% coinsurance after deductible Family planning services office visits Covered in full Family planning services purchase and insertion of IUD Infertility services Office visits (up to 12 visits outside MIT Medical per year) Routine/preventive services covered at MIT Medical only. Chiropractor office visits (up to 12 visits per calendar year) Routine vision exam (one every 12 months) Short-term rehabilitation therapy physical, occupational, and speech (up to 60 visits per calendar year) Psychotherapy Covered in full; available only at MIT Medical if you are enrolled in the Extended Plan No charge (limited services are available) Covered in full (visit limit does not apply) Not available at MIT Medical Covered in full; available only at MIT Medical if you are enrolled in the Extended Plan Not available at MIT Medical Covered in full Psychopharmacology Covered in full $25 copay $25 copay for office visits; 10% coinsurance on all other services $25 copay for office visits; $25 copay up to the benefit limit; then you pay all costs Limited coverage for children up to and including age 5 $25 copay up to the benefit limit; then you pay all costs Visits 1-12 covered in full, $25 copay per visit for all additional visits 20% coinsurance after deductible 20% coinsurance after deductible, up to the benefit limit; then you pay all costs 20% coinsurance after deductible, up to the benefit limit; then you pay all costs 20% coinsurance after deductible, up to the benefit limit; then you pay all costs Deductible waived; visits 1-12 covered in full up to the allowed amount; 20% coinsurance on all additional visits Deductible waived, 20% coinsurance Oxygen and equipment for its administration Not available at MIT Medical Covered in full 20% coinsurance after deductible MIT is required under Federal Health Care Reform to provide you with a summary of this plan s benefits, exclusions, and cost-sharing requirements. The document and a glossary of terms are available at medical.mit.edu/forms-documents/students 4

5 Effective September 1, August 31, 2017 Your cost at MIT Medical (services are covered under the MIT Student Medical Plan unless otherwise indicated) Your cost for services outside MIT Medical covered only if you are also enrolled in the MIT Student Extended Insurance Plan Your cost for benefits using the Blue Cross PPO Network (see Innetwork provider on page 7) Your cost for out-of-network provider benefits (see definition on page 7 for more information) Outpatient care Diagnostic X-rays, lab tests, and other tests Covered in full $50 copay on CT scans, MRIs, PET scans, and nuclear imaging; other services covered in full 20% coinsurance after deductible Surgery and related anesthesia office setting, ambulatory surgical facility, hospital or surgical day care unit Covered in full, but limited services available at MIT Medical Covered in full; $25 copay for office/ambulatory services 20% coinsurance after deductible Inpatient care General or chronic disease hospital care including maternity services Mental hospital or substance abuse facility care (all admissions must be authorized in advance by MIT Medical Mental Health and Counseling, except emergency admissions) Not available at MIT Medical $100 copay per admission 20% coinsurance after deductible Not available at MIT Medical $100 copay per admission 20% coinsurance after deductible Rehabilitation hospital care (up to 60 days per calendar year) Not available at MIT Medical $100 copay per admission, up to benefit limit; then you pay all costs 20% coinsurance after deductible, up to the benefit limit; then you pay all costs Other services Ambulance services Not available at MIT Medical Covered in full Deductible waived; covered in full Prescription drugs (up to a 30-day supply for each prescription) At the MIT Pharmacy if you are enrolled in the Extended Plan $0 for Tier 1 contraceptives $10 for Tier 1 medications $20 for Tier 2 medications $30 for Tier 3 medications At a participating Express Scripts pharmacy: $0 for Tier 1 contraceptives $20 for Tier 1 medications $30 for Tier 2 medications $40 for Tier 3 medications Maximum benefit: $20,000 per calendar year Durable medical equipment including wheelchairs, hospital beds, crutches, etc. Not available at MIT Medical 10% coinsurance 20% coinsurance after deductible Out-of-country coverage Services outside the United States Same coverage as within U.S.; all covered services are considered to be out-of-network. Many facilities require that you pay at time of care and then file a claim with Blue Cross Blue Shield of Massachusetts. You must contact BCBS worldwide network ( , or for collect calls) for inpatient admissions. See bluecardworldwide If traveling on an MIT-sponsored trip, you should register with International SOS prior to your departure. See link on vpf.mit.edu/ insurance for more information. 5

6 Health plans offices Member Services Team E23, 1 st floor Go to Member Services for questions about... What your plan covers Insurance ID cards Referrals Claim reimbursement forms PCP selection or changes Questions about claims mservices@med.mit.edu Enrollment Team E23, 3 rd floor Go to Health Plans for questions about... Enrolling in a health plan Adding family members to a health plan or taking them off Health plan costs Waivers Verification of enrollment stuplan@med.mit.edu THINGS TO REMEMBER Know your insurance. Some services at MIT Medical like routine eye exams, prescriptions, allergy serum, HPV vaccines, and obstetrics are not covered under the MIT Student Medical Plan but are covered under the MIT Student Extended Insurance Plan. These services may also be covered under other plans, so if you waive the Student Extended Insurance Plan, your other insurance may pay for you to receive some of these services at MIT Medical. You will be responsible for the charge if your outside insurance denies payment. Know yourself. Make sure you know what medications you re taking and any medical allergies. Always carry your insurance card, no matter what insurance coverage you have. Your privacy is protected. Unless you give us permission, we won t share anything about your visits to MIT Medical with your parents, professors, or friends. Exceptions would be made only in certain life-threatening situations. For more information on our privacy policy and your rights and responsibilities as a patient, please visit medical.mit.edu/privacy 6

7 Commonly used terms Blue Cross Blue Shield ID card A card issued to members of the MIT Student Extended Insurance Plan by Blue Cross Blue Shield of Massachusetts (BCBS). In early October, BCBS will mail ID cards for new enrollees in the Student Extended Insurance Plan to the addresses we have on file at MIT Medical. To ensure that you receive your card, please update your address both in MIT WebSIS and at MIT Medical once you have finalized your residence. If you haven t received your ID card and you need your insurance number, visit the MIT Health Plans Office in Room E23-308, call , or us at stuplan@med.mit.edu. Coinsurance The portion of eligible expenses you are responsible for paying, most often after the deductible is met. Coinsurance is usually determined as the percentage of the total provider s actual charge or the amount approved by BCBS for the service. Copayment The fixed dollar amount you need to pay when receiving certain treatments, services, or supplies. Also called a copay. Deductible The dollar amount you must pay for covered out-of-network health care services before your health plan will cover additional services that year. The deductible for the MIT Student Medical Plan is $500 per individual per calendar year. Dependent Your child, up to 26 years old. In-network provider Any health care provider (physician, hospital, etc.) that belongs to a health plan s PPO network. Using an in-network provider will usually cost you less in copayments or coinsurance. Out-of-network provider Any health care provider that does not belong to a Blue Cross Blue Shield PPO provider network. You can use out-of-network providers, but your out-of-pocket expenses will be greater. Out-of-network providers can bill you the difference between the amount approved by BCBS for the service and their actual charge, and this amount is not included in your out of pocket maximum. Out-of-pocket maximum An annual limit on the amount of money individuals are required to pay out-of-pocket for covered health care costs, excluding premiums. When the amount you ve paid in a calendar year adds up to the out-of-pocket maximum, additional services will be covered in full during the same calendar year. You may still be responsible for the difference between the approved amount and the actual charge for out-of-network services. There are three distinct out-of-pocket maximums under the Student Extended Insurance Plan: for medical services, the out-of-pocket maximum is $4,000 per individual; for prescriptions filled through the MIT Pharmacy, the out-of-pocket maximum is $1,000 per individual; and for prescriptions filled through the Express Scripts pharmacy network, there is a separate $1,000 out-of-pocket maximum per individual. Waiver A form that officially documents voluntary cancellation of enrollment in the MIT Student Extended Insurance Plan. Waivers are accepted only when students can show they have other health insurance that meets federal and Massachusetts requirements. Waivers must be submitted each academic year. The deadline for fall-term waivers is September 15. Spring-term waivers are due by February 15. Summer waivers are due by June 15. Limitations and exclusions Both the MIT Student Health Plan and the MIT Student Extended Insurance Plan cover medically necessary services only as defined in the Blue Cross Preferred Provider Benefit Description. Certain services are not covered under either plan, including, but not limited to, custodial care, most educational testing and evaluation, most experimental treatments, hearing aids and hearing aid evaluations, eyeglasses, contact lenses, over-the-counter medicines and products, diet drugs, cosmetic surgery, orthotics, psychoanalysis, dental care, and prescription vitamins. All benefits are effective September 1, This is a quick overview. If there is a conflict between this overview and the Benefit Description, including the addendum (available at medical.mit.edu/healthplans/student), the Benefit Description and/or addendum govern. If you have questions, please contact Claims and Member Services at or mservices@med.mit.edu. 7

8 Care right here on campus Remember, as an MIT student, you re covered by the MIT Student Medical Plan even if you opt out of the Student Extended Insurance Plan. With the Student Medical Plan, you can use most services at MIT Medical at no additional charge. Here are some things you should know: Choose a primary care provider (PCP): Your PCP will coordinate all your care, including necessary referrals to specialists at MIT Medical (usually covered by the Student Medical Plan) or elsewhere (covered by the Student Extended Insurance Plan or, possibly, your other insurance plan). Visit medical.mit.edu/choose to see names and photos of PCPs who are accepting new patients, get more information about individual providers, and fill out the online form to make your choice. If you are unhappy with your choice of PCP, you can change your selection at anytime. Make an appointment: If you need to be seen by a clinician, you can call your primary care provider s office directly, or call the triage nurse at If you re sick and need to be seen the same day, let us know. Urgent Care: MIT Medical s Urgent Care Service is open from 7 a.m. 11 p.m., seven days a week, 365 days a year. Mental Health and Counseling Service: On-campus clinicians provide consultation, crisis intervention, and ongoing treatment, including individual and group counseling and psychopharmacology. Services are available to all MIT students at no extra charge. Walk-in hours are available on the third floor of MIT Medical Monday through Friday from 2 4 p.m. Call to make an appointment or to talk to a clinician in urgent situations. Overnight or on weekends, you can reach a mental health clinician by calling MIT Medical s 24-hour number, For more information see medical.mit.edu/mentalhealth Community Wellness at MIT Medical: Explore resources and programs that can help you make healthy choices to get the most out of your time at MIT. Stop by E23-205, or learn more at medical.mit.edu/wellness Learn more about MIT Medical at medical.mit.edu Useful contact information 24-hour help line: Urgent Care: (For pediatric patients: during the hours that Urgent Care is open, call before coming in to find out if a pediatric clinician is available.) Appointments: Mental Health & Counseling: Urgent concerns: days: nights/weekends: Health Plans Office: or stuplan@med.mit.edu Member Services: or mservices@med.mit.edu MIT Medical Billing inquiries: or billing@med.mit.edu MIT Pharmacy: Community Wellness: MIT Student Health Plan Mailing Address E23-308, 77 Mass. Ave. Cambridge, MA